Questions to ask after diagnosis

Friday

To get good answers, you need to ask good questions. Here are a few you should ask your oncologist if you are diagnosed with breast cancer.

1. What type of breast cancer do I have?

“Invasive ductal carcinoma is the most common form of breast cancer, followed by invasive lobular carcinoma. Both of these cancers are treated the same way and only differ in the cells of the breast they grow from,” said Dr. Cletus Arciero, associate director for surgery at Glenn Family Breast Center, part of the Winship Cancer Institute of Emory University.

“There are other less-common types of breast cancers that are also treated in a similar manner, with some differences based on the specific type. Ductal carcinoma in situ is a form of breast cancer that cannot invade tissue and cannot spread to other parts of the body. It is very common and very survivable,” Arciero said.

2. What size is the tumor?

“Size of the tumor is part of the breast cancer staging system and it is important,” said breast surgical oncologist Dr. Catherine Parker, assistant professor in the University of Alabama at Birmingham Division of Surgical Oncology and associate scientist in the experimental therapeutics program at the UAB Comprehensive Cancer Center. “Initially the tumor size is based on breast imaging findings; however, the surgical specimen provides the pathologic measurement.”

3. What stage is my breast cancer?

“Breast cancer stage is based on the size of the tumor, whether cancer has spread to the lymph nodes under the arm, and whether the cancer has spread to other parts of the body,” Arciero said.

Stages 1 and 2 are considered early stage breast cancers. Stage 3 is more advanced. Stage 4, metastatic breast cancer, has spread to parts of the body beyond the breast.

4. What are the receptors for my cancer?

Cancer cells have special receptors that aid the growth of the cancer, with the three most commonly tested being estrogen (ER), progesterone (PR) and human epidermal growth factor (HER2), Arciero said.

“The ER and PR are considered the hormone receptors. If they are positive the cancer will respond to anti-hormone therapy. The HER2 receptor is positive in about 25 percent of cancers, and it means that the tumor will respond to antibody therapy,” he said.

Triple-negative breast cancers are the least common and most aggressive form of breast cancers and almost always require chemotherapy. They are negative for all three receptors, Arciero said.

5. What is the grade of my cancer, and does it matter?

“Grade is a reflection of how fast a cancer cell divides. The higher the grade, the more aggressive the cancer may be. It should not be confused with stage, though,” Arciero said.

6. Am I going to die of my breast cancer?

“Probably not. The majority of breast cancers in the United States are either Stage 0 or Stage 1,” Arciero said.

According to the American Cancer Society, the five-year relative survival rate for women with stage 0 or stage 1 breast cancer is close to 100 percent.

For women with stage 2 breast cancer, the five-year relative survival rate is about 93 percent, and for stage 3 it’s about 72 percent: Often, women with these breast cancers can be treated successfully.

Breast cancers that have spread to other parts of the body are more difficult to treat and tend to have a poorer outlook. Metastatic, or stage 4, breast cancers have a five-year relative survival rate of about 22 percent. Still, there are often many treatment options available for women with this stage of cancer.

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